Cancer pain management

The pain of cancer is usually constant, so it needs well-managed, regular relief. A person whose pain is well controlled has a better quality of life: they are more likely to sleep well and to stay active. Being as active as possible also lowers the risk of problems linked with immobility, such as pneumonia, blood clots and bedsores.

The foundation of cancer pain management is regular medication, including aspirin-like drugs, paracetamol (acetaminophen) and opioid drugs, chosen to suit each person and to keep side effects to a minimum. Treatments aimed at the cancer itself, such as radiotherapy, surgery, hormone therapy or chemotherapy, may also relieve pain if they reduce the size of a tumour.

Combining medications is common#

Using more than one medication together is a common way to get the best relief. The type of pain a person has influences which medications are chosen and how they are used.

Some of the factors that guide treatment choices include:

• the location of the pain
• the severity of the pain
• the type of pain, such as sharp, tingling or aching
• whether the pain is constant or comes and goes
• what activities or events make the pain better or worse
• the impact the pain has on daily life, such as poor sleep or loss of appetite
• the current medications and how much they ease the pain

People respond differently to pain-relieving medicines, so treatment is always individual.

Types of medication for cancer pain#

Aspirin-like drugs are used for bone pain and pain caused by inflammation, such as pleurisy. Some people get stomach problems with this type of medication, such as indigestion or bleeding. Aspirin itself is usually avoided for regular use because it is too hard on the stomach.

Paracetamol (acetaminophen) is important in cancer pain control. It is usually well tolerated, does not upset the stomach and does not thin the blood. It helps reduce fever and relieve bone pain, and is often used alongside opioids.

Opioids, such as codeine and morphine, are a mainstay of cancer pain relief. Side effects may include nausea, vomiting, drowsiness and constipation. There is no danger of addiction when they are taken for pain relief. Several newer opioids are available, so a suitable one can usually be found.

Many people worry about taking opioids, fearing addiction or believing they should wait until they are very ill. The evidence shows it is far better to find a suitable opioid and use it regularly once your pain becomes constant. This makes it easier to keep up the activities and interests you enjoy.

Different forms of pain-relieving medication#

Pain medication can be given in several ways:

• Tablets or syrups are taken by mouth and are simple to use. If nausea or vomiting is a problem, they may not be practical.
• Injections under the skin are painless, effective and quick acting. A continuous infusion under the skin can be set up and maintained at home using a small portable pump.
• Intravenous injections deliver medication straight into the bloodstream through a slender tube (catheter) placed in a vein. This works faster than tablets, syrups or regular injections, but is inconvenient for long-term use at home.
• Spinal injections deliver medication through a small catheter in the back (epidural catheter). This must be done by an anaesthetist and is generally used when other methods have not worked.

Managing your medication#

Because cancer pain is usually constant, it is best to take the prescribed doses regularly rather than wait for pain to strike. When pain is well managed, you are less likely to need large doses, which reduces the risk of side effects.

Be guided by your doctor. General suggestions include:

• Take your medications regularly, according to your doctor’s advice. Each medicine lasts a different length of time in the body, so each must be taken at the right frequency.
• Get to know your medication: how it works, how long it lasts, its side effects and anything else you need to know.
• Keep an up-to-date record of your current medications and doses. Your doctor, nurse or pharmacist can help with this.
• Always keep enough medication on hand to last at least a week.
• Take enough medication before bed to allow uninterrupted sleep. For example, if a preparation lasts four hours, your doctor may suggest a double dose at night so you can sleep for eight hours rather than waking for the next dose. If needed, set an alarm so you don’t miss a dose. If you wake in the morning with significant pain, this may help improve your control.
• Have your medications reviewed regularly. Doses may need to go up or down depending on what is happening with your cancer and with you.

Questions about opioids#

Most people have questions and concerns about opioids. These are best discussed with a pain specialist. Specialist nurses and doctors are available in most large hospitals and can sit and talk through your concerns; they often work in palliative care teams and can be contacted through the hospital switchboard. Common questions include:

• Will regular painkillers stop me knowing if my cancer is getting worse?
• Will I become dependent on the drugs?
• If I take medication now, will it stop working later when I really need it?
• My doctor says I should only use opioids when I am in really bad pain, and only a small amount, but this means I have a lot of pain most days. What can I do?
• Will taking opioids shorten my life?
• My family are upset that I am on opioids. How can I explain it to them?

Relaxation and other approaches#

Deep physical and mental relaxation reduces anxiety and can help a person cope better with pain. Your doctor may be able to recommend reputable therapists; otherwise, ask friends or contact the professional association for your chosen therapy for a list of members in your area. Helpful approaches may include:

• Breathing and relaxation – studies show that correct breathing, using the diaphragm and abdomen, can soothe the nervous system and help manage stress.
• Hypnotherapy – uses imagery to bring about a dreamy, relaxed state of mind. It can also help ease some side effects of cancer treatment, such as nausea.
• Massage – the skin is the body’s largest organ and is full of nerve endings. Massage soothes soft tissue and encourages relaxation.
• Meditation – the deliberate clearing of the mind to bring calm and heightened awareness. Regular practice offers long-term benefits, such as reduced stress and lower blood pressure.
• Tai chi – a gentle, non-combative form of movement that helps clear the mind and relax the body.
• Yoga – an ancient system of postures synchronised with the breath.

Other techniques that may help ease chronic pain include:

• Acupuncture – an ancient form of medicine that involves inserting fine needles, though there is little research looking specifically at cancer pain.
• Transcutaneous electrical nerve stimulation (TENS) therapy – a tiny electrical current is passed through the skin via electrodes, prompting a pain-relieving response from the body.

Key points#

• Combining medications to gain maximum benefit is common.
• People respond differently to pain-relieving medicines, so treatment is always individual.
• Aspirin itself is generally avoided because it is too hard on the stomach when taken regularly.
• Managing pain well makes it easier to keep up the activities and interests you enjoy.
• A continuous infusion under the skin can be set up and maintained at home using a small portable pump.

Where to get help#